title: Supramalleolar osteotomy: a comparison of fixation methods.
abstract: BACKGROUND
  For children with persistent tibial torsion, a wide variety of osteotomies and fixation methods have been proposed. We set out to compare the outcomes of percutaneous pin fixation versus a plate and screw construct. Our hypothesis was that the pin fixation group would have comparable outcomes without the need for a secondary procedure for implant removal.
  
  
  METHODS
  A retrospective chart review was performed. Data were evaluated on patients undergoing a rotational supramalleolar osteotomy over a 10-year span with follow-up to union. Patient's age, underlying condition, degree of torsion, length of procedure, length of hospital stay, concomitant procedures, complications, recurrence, and secondary procedures were recorded. Statistical analysis utilized the Mann-Whitney U test for evaluation of independent samples.
  
  
  RESULTS
  A total of 125 patients met the selection criteria with 186 tibias operated. Sixty-one cases were bilateral. Pin fixation was performed in 61 patients (87 tibias) and plate fixation in 64 patients (99 tibias). Age ranged from 2.5 to 19.6 (average 10.6) years. Surgical time, length of stay, and recurrence did not demonstrate a statistically significant difference between the pin fixation and the plate fixation groups. Forty-seven patients had secondary surgical procedures for removal of implants, 44 in the plate group and 3 in the pin group. Complications were considered major if they required reoperation or fracture care. In the plate group, 16 patients (12.8%) had complications with 5 major complications. In the pins group 3 patients (2.4%) had complications, which were minor. Recurrence was seen in 4 patients in the pin group and 2 patients in the plate group. Recurrence correlated with underlying neuromuscular disease and age younger than 11 years at the time of surgery.
  
  
  CONCLUSIONS
  The numbers of complications, both major and minor, were significantly greater in the plate group. Therefore, the results of this study did not support our hypothesis that percutaneous pin fixation of supramalleolar osteotomies would have comparable outcomes to plate and screw fixation.
authors.affiliation: Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA. cderoode@cmh.edu
authors.forename: Carolien P
authors.initials: CP
authors.lastname: de Roode
authors.forename: Man
authors.initials: M
authors.lastname: Hung
authors.forename: Peter M
authors.initials: PM
authors.lastname: Stevens
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001858:Bone Nails; D001860:Bone Plates; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D061646:Operative Time; D010027:Osteotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013977:Tibia / Q000002:abnormalities / Q000601:surgery*; D014102:Torsion Abnormality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult